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A pharmacist in Ghana.

Richard Lord.

Pharmacies serve as a first source of health care for people throughout the world, particularly in low income and rural areas.  Pharmacists can provide advice on health issues, access to medications, counseling and even direct service provision. The World Health Organization asserts that as health care becomes more fragmented and commercialized around the world, self-diagnosis and the use of pharmacies as a source of health care are likely to become more common among the poor and uninsured. In fact, women seeking information about abortion services, including medical abortion, often turn to pharmacists first. Ipas is currently working with pharmacists to improve access to and distribution of medication for medical abortion.

Also called medication abortion or the abortion pill, medical abortion consists of pills — either a combination of mifepristone and misoprostol, or misoprostol by itself — that end a pregnancy through a process similar to miscarriage. It is safe, effective and noninvasive, and in many settings is available at pharmacies. Even where it is available, however, pharmacy workers may sell the wrong medicines or give the wrong doses or information about its use. Some may also simply not be willing to dispense it.  

Despite these challenges, research indicates that pharmacists who understand the severe consequences of unsafe abortion and who are informed about the effectiveness of medical abortion want information and training on its correct use, and are willing to stock and dispense medical abortion drugs. Given pharmacists’ connection to the community, especially among low-resource settings, and women’s desire to use pharmacies as a source of information on abortion, evidence suggests that pharmacists can help meet the need for safe abortion care. “Pharmacists are the linchpin between the community and the health system. They provide valuable healthcare services that are acceptable and convenient for women and are important partners in the fight to end unsafe abortion,” says Robyn Sneeringer, Ipas medical abortion associate. Ipas has engaged in projects in several countries to determine how pharmacists are meeting the community’s need for these medicines, and how their practices can be improved.

Ongoing efforts in Africa and Latin America

In Ghana, abortion is permitted to save the woman’s life and in cases of rape or incest, and also to preserve her physical and mental health. Still, even though safe services are increasingly available through the health-care system, many women continue to die and suffer from the consequences of unsafe abortion.  In October 2009, Ipas Ghana organized a workshop for female pharmacists in partnership with the Ghana Women’s Voices Foundation, an organization promoting women’s empowerment professionally and politically through mentorship programs. In a recent AllAfrica article covering the workshop, Ghana Women’s Voices Foundation leader Nana Yaa Appiah decried the fact that women who ask for help at pharmacies are often turned away or are sometimes given inadequate medicines which can be harmful. During the workshop, participants discussed abortion and abortion methods, the legal indications for abortion and how they could help women get safer, better services.  In Ghana, pharmacists are not permitted by law to prescribe medication for abortion but can dispense on prescription, counsel and refer clients for safe services. By sensitizing pharmacists in these communities to the needs of clients seeking abortion services and providing them with accurate information, Ipas hopes to make safe abortion more accessible to Ghanaian women.

In Mexico City, abortion is legal during the first trimester of pregnancy and medical abortion with misoprostol is offered by the health system. However, studies have found that a large majority of pharmacists do not have sufficient information about the correct use of misoprostol for abortion. Studies have also shown that women come to pharmacies for information on medical abortion, highlighting the importance of training pharmacists to be able to provide accurate information.  

Despite services being offered in public-sector health facilities, some women continue to resort to medical abortion outside of the formal health-care system, purchasing and taking misoprostol without correct information on its use.  In 2006, a year before the legalization of abortion in Mexico City, Ipas Mexico conducted a study on medical abortion with young people in high schools located in marginalized areas of the city. Results showed that 73 percent of young women were aware of the existence of misoprostol as an abortion method, but only 4 percent knew its commercial brand name and none of them had information on the correct dosage. That same year, Ipas Mexico conducted a study on pharmacy workers’ knowledge and practices related to misoprostol in the state of Morelos, Mexico. They found that 84 percent of pharmacy workers offered ineffective medical abortion regimens based on incorrect dosages. Both studies indicated a strong need to provide correct medical abortion information to women and to pharmacy workers, and others who help women who are seeking abortion.

In response, Ipas Mexico is in the process of designing educational materials to provide correct medical abortion information to pharmacy workers and their clients. Materials include an online, interactive tool to educate young people on medical abortion; help them identify safe versus unsafe practices; know contraindications to medical abortion; and refer them to the formal health sector if they need services. This tool will also be adapted to the needs of community-based providers, such as pharmacy workers.

Pharmacists do more than sell medicines; they manage health conditions, and they can be partners to women in managing their reproductive health needs.

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For more information, contact media@ipas.org